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1.
Dermatol Ther ; 35(2): e15231, 2022 02.
Article in English | MEDLINE | ID: mdl-34820971

ABSTRACT

Data on the effectiveness and safety of a drug in real-world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice. The ojective of this study was to assess the effectiveness and safety of guselkumab at 24 weeks in patients with moderate to severe plaque psoriasis in routine clinical practice. A retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks was carried out in Spain. We studied 343 patients, 249 of whom were followed for 24 weeks. By week 24, the mean (SD) psoriasis area severity index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (-9.3; [-10.2;-8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI-90 response and 49.0% a PASI-100 response. On multivariate analysis, two factors reduced the probability of a PASI of 2 or less at 24 weeks: a BMI ≥30 (OR, 0.44; 95% CI, 0.22-0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, [0.56-0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only nine patients (2.6%) by the end of the follow-up period. The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value.


Subject(s)
Psoriasis , Adult , Antibodies, Monoclonal, Humanized , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Retrospective Studies , Severity of Illness Index , Treatment Outcome
2.
Sci Rep ; 12(1): 7469, 2022 May 06.
Article in English | MEDLINE | ID: mdl-35523995

ABSTRACT

In clinical settings, although Psoriasis Area and Severity Index (PASI) scoring system can provide a quick visual assessment of the severity of psoriasis vulgaris, there is still a strong demand for higher efficiency and accuracy in quantifying the inflammation status of psoriatic lesions. Currently, there are already commercial systems, such as the Courage + Khazaka Corneometer and Mexameter that measure skin capacitance and optical reflectance, for conveniently quantifying the status of skin barrier function and erythema of skin. Despite numerous comparisons of the Courage + Khazaka system with the PASI scoring system, they are rarely compared on parity with diffuse reflectance spectroscopy (DRS) based systems. In this study, we employed a custom-built DRS system shown to be able to determine the skin water-protein binding status and the hemoglobin concentration, and we performed cross-validation of the DRS measurement results with the readings derived from the Corneometer and Mexameter as well as a portion of the PASI scores. Our results revealed that the erythema readings from the Mexameter were a good representation of skin oxygenated hemoglobin but not the deoxygenated hemoglobin. On the other hand, the dermatologists recruited in this study were inclined to rate higher scores on the "erythema" category as skin's deoxygenated hemoglobin level was higher. Thus, the Mexameter derived erythema readings may not be coherent with the PASI erythema scores. Further, the Corneometer derived skin capacitance readings were well correlated to the PASI "desquamation" and "thickness" scores, while the PASI "desquamation" evaluation was a dominating factor contributing to the DRS deduced water-protein binding status. We conclude that the DRS method could be a valuable addition to existing skin capacitance/reflectance measurement systems and the PASI scoring system toward achieving a more efficient and objective clinical psoriasis vulgaris severity evaluation.


Subject(s)
Psoriasis , Erythema/diagnosis , Erythema/pathology , Hemoglobins , Humans , Psoriasis/diagnosis , Psoriasis/pathology , Severity of Illness Index , Water
3.
Ned Tijdschr Geneeskd ; 1662022 03 21.
Article in Dutch | MEDLINE | ID: mdl-35499542

ABSTRACT

BACKGROUND: Nail psoriasis, also called psoriasis unguium, is a variant of psoriasis in which nail changes appear due to inflammation of nail bed or nail matrix. 15% to 50% of patients with cutaneous psoriasis have nail psoriasis, the condition also occurs without or before the appearance of skin lesions. CASE DESCRIPTION: A 54-year-old male visits his general practitioner because of crumbling of his fingernails. Upon clinical examination, this was interpreted as onychomycosis and treated with oral antimycotics. Due to the lack of improvement and a negative PCR-test on dermatophytes, the condition was later diagnosed as nail psoriasis. CONCLUSION: Nail psoriasis is often diagnosed as fungal infection of the nails. To make the right diagnosis, a complete medical history should be obtained, and physical examination of skin and joints need to be conducted. Furthermore, we advise to rule out onychomycosis in patients with known skin psoriasis to prevent overtreatment with antimycotics.


Subject(s)
Nail Diseases , Onychomycosis , Psoriasis , Humans , Male , Middle Aged , Nail Diseases/diagnosis , Nails/pathology , Onychomycosis/complications , Onychomycosis/diagnosis , Onychomycosis/microbiology , Psoriasis/diagnosis , Skin/pathology
4.
Niger Postgrad Med J ; 29(2): 155-160, 2022.
Article in English | MEDLINE | ID: mdl-35488585

ABSTRACT

Background: Psoriasis is a chronic inflammatory skin disease which may be associated with joint, cardiovascular, metabolic or psychiatric disease. Countries in North America, Northern Europe and Australia have the highest burden of disease while those in Asia, South America and Africa, the lowest. We report our experience of psoriasis in Kaduna, Nigeria, over 20 years and compare this with previous reports in the same area and in other parts of Nigeria and Africa. Objective: To report the relative incidence, clinical presentation, severity and associations of psoriasis seen over 20 years. Methods: A retrospective review of records of patients with psoriasis seen at two outpatient dermatology clinics in Kaduna, North-West Nigeria, over 20 years. Results: Diagnosis of psoriasis was made in 218 of 39,037 (0.6%) patients with new skin disease: Mean age 35.2 years, range (6 months to 80 years), 60% <40 years, males constituted 64.2%. Mean age of onset was 30.5 years with a quarter developing psoriasis before age 20 and 71.4% before 40 years. Psoriasis presented earlier in females than males (mean age of onset 27.6 vs. 32.2 years, P= 0.052) but was less severe. Psoriasis types were: Plaque 88.1%, guttate 6%, erythrodermic 4.6% and sebopsoriasis 0.9%. Only four patients had joint disease and other associations were infrequent. Overall, 80.3% had mild psoriasis and 13.2% had a family history. Conclusion: Psoriasis remains a rare and mild disease in Kaduna and is infrequently associated with joint and other systemic disease but similar in other respects to the condition elsewhere.


Subject(s)
Psoriasis , Skin Diseases , Adult , Aged , Female , Humans , Incidence , Infant , Male , Middle Aged , Nigeria/epidemiology , Psoriasis/diagnosis , Psoriasis/epidemiology , Retrospective Studies , Young Adult
5.
J Drugs Dermatol ; 21(4): 399-407, 2022 Apr 01.
Article in English | MEDLINE | ID: mdl-35389589

ABSTRACT

BACKGROUND: There is a paucity of long-term real-world evidence comparing the effectiveness of ixekizumab (IXE) and adalimumab (ADA). We compared real-world treatment patterns of IXE-treated and ADA-treated patients with psoriasis over 24 months in the United States. METHODS: A retrospective observational study was conducted using IBM Watson Health MarketScan® databases. Adult patients with psoriasis having ≥1 claim for IXE or ADA from March 1, 2016 – October 31, 2019 were identified. Inverse probability of treatment weighting (IPTW) was used to address cohort imbalances. Cox proportional hazards models were used to estimate the risks of non-persistence, discontinuation, and switching. Logistic regression was used to estimate odds of high adherence. Persistence, adherence, discontinuation, reinitiation, and dosing and switching rates were also analyzed. RESULTS: The final cohorts comprised 475 IXE users and 3159 ADA users over 24 months. IXE users demonstrated higher adherence (36.3% vs 28.8%; P<0.001) and persistence rates (35.2% vs 28.8%; P=0.004), and a lower discontinuation rate (59.1% vs 65.3%; P=0.007) compared to ADA users. IXE users had a higher likelihood of being treatment-adherent compared to ADA users (OR=1.52, 95% CI: 1.24–1.87), a lower risk of non-persistence (HR=0.84, 95% CI: 0.75–0.95), and a lower risk of discontinuation (HR=0.83, 95% CI: 0.74–0.94), respectively. Switching rates were similar in both groups (31.2% vs 30.0%; P=0.608). CONCLUSION: IXE users had better treatment adherence and persistence, and a lower risk of discontinuation compared to ADA users over 24 months. There was no difference in the risk of switching between IXE and ADA. J Drugs Dermatol. 2022;21(4):399-407. doi:10.36849/JDD.6336.


Subject(s)
Antirheumatic Agents , Psoriasis , Adalimumab/therapeutic use , Adult , Antibodies, Monoclonal, Humanized/therapeutic use , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Retrospective Studies , United States/epidemiology
6.
J Drugs Dermatol ; 21(4): 381-386, 2022 Apr 01.
Article in English | MEDLINE | ID: mdl-35389594

ABSTRACT

Even in light of significant recent therapeutic advancements, many patients with psoriasis will use a combination of treatments at some point in the disease course. Despite the frequency with which combinations are used in clinical practice, there are few large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis. Twice-weekly maintenance application of topical Cal/BD aerosolized foam has recently been shown to prolong time to remission and is associated with fewer relapses in patients initially treated with standard dosing of the formulation. Data from a small number of pilot studies suggest potential benefits from the combined used topical Cal/BD foam with oral apremilast. This pilot study assesses the effect of twice-weekly maintenance doses of Cal/BD foam after 4 weeks of standard once-daily treatment in combination with apremilast. The combination of apremilast plus Cal/BD achieved the primary endpoint, with 95% of subjects rated clear or almost clear on PGA at week 4. Subject’s global assessment scores showed similar improvement to PGA scores at week 4 (47% of subjects clear or almost clear). Ten subjects (53%) achieved PASI 75 at week 4, and 12 (63%) achieved PASI 75 at week 16. Maintenance dosing of Cal/BD foam in combination with apremilast is safe and effective for the management of moderate psoriasis. J Drugs Dermatol. 2022;21(4):381-386. doi:10.36849/JDD.6622.


Subject(s)
Dermatologic Agents , Psoriasis , Aerosols/therapeutic use , Betamethasone/analogs & derivatives , Calcitriol/analogs & derivatives , Drug Combinations , Humans , Pilot Projects , Prostaglandins A/therapeutic use , Psoriasis/chemically induced , Psoriasis/diagnosis , Psoriasis/drug therapy , Thalidomide/analogs & derivatives , Treatment Outcome
7.
Ital J Dermatol Venerol ; 157(2): 132-136, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35391533

ABSTRACT

Acrodermatitis continua of Hallopeau is a sterile pustular dermatosis primarily of the digits. Often considered a type of pustular psoriasis, it may be difficult to diagnose and even more difficult to treat. Initial involvement of a distal finger or toe may appear as erythema which should not be confused with the chilblains-like findings potentially associated with COVID-19 infection. We review the clinical manifestations of and explore potential therapeutic options for this uncommon, clinically striking dermatosis.


Subject(s)
Acrodermatitis , COVID-19 , Psoriasis , Skin Diseases, Vesiculobullous , Acrodermatitis/diagnosis , Extremities , Humans , Psoriasis/diagnosis
8.
J Drugs Dermatol ; 21(4): 354-370, 2022 04 01.
Article in English | MEDLINE | ID: mdl-35389586

ABSTRACT

BACKGROUND: Despite the emergence of multiple biologic drug options for psoriasis, unmet treatment needs remain. Biologic therapies can vary in their effectiveness and adverse events, and many patients experience a loss of treatment effect over time. After lack of response, treatment may be switched to a biologic with a different mechanism of action. Brodalumab, a human interleukin-17 (IL-17) receptor A antagonist, is approved for the treatment of adult patients with moderate-to-severe psoriasis with inadequate response or loss of response to prior systemic therapies. Because brodalumab targets the IL-17 receptor instead of the ligand itself, it not only targets a broader set of IL-17 isoforms but also may be effective in patients who received prior IL-17 inhibitors or failed to respond to anti–IL-17 treatment. This is supported by long-term evidence from clinical trials and real-world studies of patients receiving brodalumab who were previously treated with IL-17 inhibitors. Additionally, brodalumab produces reliable treatment effects after use of biologics with other mechanisms of action, such as tumor necrosis factor α and IL-12/IL-23 inhibitors, as well as after the use of multiple biologic therapies. For patients with psoriasis with inadequate response to one or more biologic therapies, brodalumab is an option that has the ability to lead to long-term skin clearance. J Drugs Dermatol. 2022;21(3):364-370. doi:10.36849/JDD.6743.


Subject(s)
Biological Products , Psoriasis , Adult , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Biological Products/adverse effects , Humans , Interleukin-17 , Psoriasis/chemically induced , Psoriasis/diagnosis , Psoriasis/drug therapy , Receptors, Interleukin-17 , Severity of Illness Index , Treatment Outcome
9.
J Healthc Eng ; 2022: 2113769, 2022.
Article in English | MEDLINE | ID: mdl-35463691

ABSTRACT

Traditional Chinese medicine classifies psoriasis (Ps) according to clinical manifestations, and its different clinical manifestations imply the pathogenesis and material evolution basis of Ps, especially biomarkers that are meaningful to identification of Ps, treatment response, and elucidation of the pathogenesis of the disease. This study aims to screen differential metabolites in plasma of psoriasis vulgaris (PV) of blood heat syndrome based on a widely targeted metabolomic technique and to analyze syndrome metabolic markers and metabolic pathways. Forty-five PV patients were recruited, including 21 cases of the blood heat syndrome group (BH-PPG), 24 cases of the non-blood-heat syndrome group (NBH-PPG), and 30 healthy cases of the normal control group (NPG). The UPLC-MS/MS detection platform, a self-developed database, and multivariate statistical analysis were applied to investigate the plasma metabolic differences. The biomarkers related to blood heat syndrome were screened using the principal component analysis method. A total of 479 metabolites were detected in the three groups of plasma samples; 72 different metabolites were sorted out in the BH-PPG/NPG group, 82 in the NBH-PPG/NPG group, and 8 in the BH-PPG/NBH-PPG group. Differential metabolites mainly consist of metabolites of organic acids, amino acids, carbohydrates, and nucleotides. Multiple metabolites ginkgolic acid, pyrroloquinoline quinone, L-aspartic acid, and citramalic acid were expected to be the potential biomarkers of blood heat syndrome PV. The formation and evolution processes may be associated with disorders and regulation of metabolic pathways, ferroptosis, carbon metabolism, and purine metabolism.


Subject(s)
Psoriasis , Tandem Mass Spectrometry , Biomarkers , Chromatography, Liquid , Hot Temperature , Humans , Psoriasis/diagnosis
10.
J Dermatol Sci ; 105(3): 176-184, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35248465

ABSTRACT

BACKGROUND: Real-life evidence on the quality of treatment with brodalumab in patients with plaque psoriasis based on patient-reported outcomes remains limited. OBJECTIVE: To assess the effectiveness of brodalumab in achieving treatment satisfaction for real-life Japanese patients with psoriasis. METHODS: As part of a single-arm, open-label, multicenter, prospective study (ProLOGUE), Psoriasis Area and Severity Index (PASI) scores, body surface area (BSA), and Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) domain scores were assessed at baseline and Weeks 12 and 48 of brodalumab treatment. Patient Global Assessment (PtGA) scores were captured at Weeks 12 and 48. RESULTS: Seventy-five patients were enrolled, of whom 73 received brodalumab. PASI scores and BSA significantly reduced from baseline at Weeks 12 and 48 (all P < 0.0001). Most (90%) patients felt the treatment was effective on the PtGA scale at Weeks 12 and 48. TSQM-9 domain scores significantly improved at Weeks 12 and 48 (all P < 0.0001). A PASI score of ≤ 2 was suggested as a treatment goal for biologic treatment of psoriasis from a receiver operating characteristic curve analysis, although some of the TSQM-9 domain scores did not improve in patients achieving this goal. No new safety signals were observed. CONCLUSION: Treatment with brodalumab was associated with improved objective symptoms and satisfaction in Japanese patients with psoriasis. A PASI score of ≤ 2 as a goal for biologic treatment of psoriasis may be feasible, although achieving this PASI goal alone may be insufficient to clearly improve long-term patient satisfaction (Japan Registry of Clinical Trials identifier: jRCTs031180037).


Subject(s)
Personal Satisfaction , Psoriasis , Antibodies, Monoclonal, Humanized , Humans , Patient Satisfaction , Prospective Studies , Psoriasis/diagnosis , Psoriasis/drug therapy , Severity of Illness Index , Treatment Outcome
11.
Front Immunol ; 13: 835760, 2022.
Article in English | MEDLINE | ID: mdl-35309349

ABSTRACT

Early diagnosis of psoriatic arthritis (PSA) is important for successful therapeutic intervention but currently remains challenging due, in part, to the scarcity of non-invasive biomarkers. In this study, we performed single cell profiling of transcriptome and cell surface protein expression to compare the peripheral blood immunocyte populations of individuals with PSA, individuals with cutaneous psoriasis (PSO) alone, and healthy individuals. We identified genes and proteins differentially expressed between PSA, PSO, and healthy subjects across 30 immune cell types and observed that some cell types, as well as specific phenotypic subsets of cells, differed in abundance between these cohorts. Cell type-specific gene and protein expression differences between PSA, PSO, and healthy groups, along with 200 previously published genetic risk factors for PSA, were further used to perform machine learning classification, with the best models achieving AUROC ≥ 0.87 when either classifying subjects among the three groups or specifically distinguishing PSA from PSO. Our findings thus expand the repertoire of gene, protein, and cellular biomarkers relevant to PSA and demonstrate the utility of machine learning-based diagnostics for this disease.


Subject(s)
Arthritis, Psoriatic , Psoriasis , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/genetics , Biomarkers , Epitopes , Humans , Machine Learning , Male , Prostate-Specific Antigen , Psoriasis/diagnosis , Psoriasis/genetics , Transcriptome
12.
J Tradit Chin Med ; 42(1): 132-139, 2022 02.
Article in English | MEDLINE | ID: mdl-35294133

ABSTRACT

OBJECTIVE: To treat patients with psoriasis vulgaris using Traditional Chinese Medicine (TCM), one must stratify patients into subtypes (known as TCM syndromes or Zheng) and apply appropriate TCM treatments to different subtypes. However, no unified symptom-based classification scheme of subtypes (Zheng) exists for psoriasis vulgaris. The present paper aims to classify patients with psoriasis vulgaris into different subtypes via the analysis of clinical TCM symptom and sign data. METHODS: A cross-sectional survey was carried out in Beijing from 2005-2008, collecting clinical TCM symptom and sign data from 2764 patients with psoriasis vulgaris. Roughly 108 symptoms and signs were initially analyzed using latent tree analysis, with a selection of the resulting latent variables then used as features to cluster patients into subtypes. RESULTS: The initial latent tree analysis yielded a model with 43 latent variables. The second phase of the analysis divided patients into three subtype groups with clear TCM Zheng connotations: 'blood deficiency and wind dryness'; 'blood heat'; and 'blood stasis'. CONCLUSIONS: Via two-phase analysis of clinic symptom and sign data, three different Zheng subtypes were identified for psoriasis vulgaris. Statistical characteristics of the three subtypes are presented. This constitutes an evidence-based solution to the syndromedifferentiation problem that exists with psoriasis vulgaris.


Subject(s)
Medicine, Chinese Traditional , Psoriasis , Cross-Sectional Studies , Hot Temperature , Humans , Medicine, Chinese Traditional/methods , Psoriasis/diagnosis , Psoriasis/therapy , Syndrome
14.
Br J Dermatol ; 186(3): e111-e133, 2022 03.
Article in English | MEDLINE | ID: mdl-35254681

ABSTRACT

Linked Article: Szabó et al. Br J Dermatol 2022; 186:485-495. Dermatology Life Quality Index (DLQI) and Skindex-16 are among the most commonly used questionnaires to measure health-related quality of life in patients with dermatological conditions. DLQI has an alternative version with different scoring named DLQI-R. In order to understand the differences in the three measures better we compared how accurately these questionnaires can measure health-related quality of life. We surveyed 618 patients with self-reported physician-diagnosed dermatological conditions in Hungary. The most common diagnoses were warts (23%), eczema (23%), onychomycosis (18%), acne (13%) and psoriasis (13%). The most interesting finding in the study was that 64% of patients that reported no problems with their health-related quality of life using DLQI or DLQI-R, reported problems using Skindex-16. The authors found that Skindex-16 and DLQI-R outperformed the DLQI in the majority of measurement properties. In patients with mild symptoms, DLQI and DLQI-R might not be able to capture small impairments in health-related quality of life, and therefore, Skindex-16 seems more suitable in this population. The results suggest that the higher number of response options and their 'frequency' format in the Skindex-16 questions seem more useful to report problems in patients' lives than the fewer 'severity' format categories of the DLQI (how often you experience problems versus how severe they are). This study helps physicians and researchers in deciding which questionnaire to use in daily practice and also for research purposes.


Subject(s)
Acne Vulgaris , Eczema , Psoriasis , Eczema/diagnosis , Humans , Psoriasis/diagnosis , Quality of Life , Surveys and Questionnaires
15.
RMD Open ; 8(1)2022 03.
Article in English | MEDLINE | ID: mdl-35347068

ABSTRACT

OBJECTIVE: Can ultrasound (US), MRI and X-ray applied to the distal interphalangeal (DIP)-joint and synovio-entheseal complex (SEC) discriminate between patients with psoriatic arthritis (PsA), skin psoriasis (PsO) and hand osteoarthritis (OA)? METHODS: In this prospective, cross-sectional study, patients with DIP-joint PsA and nail involvement (n=50), PsO with nail involvement (n=12); and OA (n=13); were consecutively recruited. Risk ratios (RR) were calculated for US, MRI and X-ray findings of the DIP-joint and SEC between diagnoses. RESULTS: New bone formation (NBF) in US and MRI was a hallmark of OA, reducing the risk of having PsA (RR 0.52 (95% CI 0.43 to 0.63) and 0.64 (95% CI 0.56 to 0.74). The OA group was different from PsA and PsO on all MRI and X-ray outcomes reflected in a lower RR of having PsA; RR ranging from 0.20 (95% CI 0.13 to 0.31) for MRI bone marrow oedema (BMO) to 0.85 (95% CI 0.80 to 0.90) in X-ray enthesitis. No outcome in US, MRI or X-ray was significantly associated with a higher risk of PsA versus PsO, although there was a trend to a higher degree of US erosions and NBF in PsA. 82% of PsA and 67% of PsO was treated with disease modifying antirheumatic drugs which commonly reflects the clinical setting. CONCLUSION: High grade of US, MRI and X-ray NBF reduce the RR of having PsA compared with OA. In PsA versus PsO patients, there was a trend for US to demonstrate more structural changes in PsA although this did not reach significance.


Subject(s)
Arthritis, Psoriatic , Osteoarthritis , Psoriasis , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnostic imaging , Arthritis, Psoriatic/drug therapy , Cross-Sectional Studies , Humans , Multimodal Imaging , Osteoarthritis/complications , Osteoarthritis/diagnostic imaging , Prospective Studies , Psoriasis/diagnosis , Psoriasis/diagnostic imaging
16.
Dermatol Surg ; 48(5): 539-544, 2022 May 01.
Article in English | MEDLINE | ID: mdl-35333217

ABSTRACT

BACKGROUND: Nail psoriasis has a major negative impact on physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of difficult penetration of the drug into the nail. OBJECTIVE: To evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis. MATERIALS AND METHODS: Twenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The improvement of nail psoriasis was assessed by clinical and dermoscopic evaluation. RESULTS: At the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p = .18), matrix score (p = .38), bed score (p = .23), and dermoscopic score (p = .78). However, the pain and subungual hematoma were significantly less in the laser group (p < .001 and p = .03, respectively). CONCLUSION: Fractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.


Subject(s)
Lasers, Gas , Nail Diseases , Psoriasis , Humans , Injections, Intralesional , Lasers, Gas/therapeutic use , Methotrexate , Nail Diseases/diagnosis , Nail Diseases/drug therapy , Nails , Psoriasis/diagnosis , Psoriasis/drug therapy
18.
Anal Chem ; 94(14): 5538-5545, 2022 04 12.
Article in English | MEDLINE | ID: mdl-35315641

ABSTRACT

Skin interstitial fluid (ISF) containing a great variety of molecular biomarkers derived from cells and subcutaneous blood capillaries has recently emerged as a clinically potential component for early diagnosis of a wide range of diseases; however, the minimally invasive sampling and detection of cell-free biomarkers in ISF is still a key challenge. Herein, we developed microneedles (MNs) that consist of gelatin methacryloyl (GelMA) and graphene oxide (GO) for the enrichment and sensitive detection of multiple microRNA (miRNA) biomarkers from skin ISF. The GO-GelMA MNs exhibited robust mechanical properties, fast sampling kinetics, and large swelling capacity, which enabled collecting ISF volume high to 21.34 µL in 30 min, facilitating effective miRNA analysis. It preliminarily realized the sensitive detection of three types of psoriasis-related miRNAs biomarkers either on the patch itself or in solution after release from the hydrogel by combining catalytic hairpin assembly signal amplification reaction. The automated and minimally invasive ISF miRNA detection technology of GO-GelMA MNs has great potential to monitor cell-free clinically informative biomarkers for personalized diagnosis and prognosis.


Subject(s)
MicroRNAs , Psoriasis , Biomarkers , Extracellular Fluid , Gelatin , Humans , Methacrylates , Needles , Psoriasis/diagnosis
19.
Acta Derm Venereol ; 102: adv00678, 2022 Mar 25.
Article in English | MEDLINE | ID: mdl-35312022

ABSTRACT

Psoriasis is a chronic, systemic inflammatory disease that affects the skin, with a high impact on patients' quality of life. The aim of this study was to identify and determine the relative importance of unmet needs in the management of moderate-to-severe psoriasis in Spain, from a multi-stakeholder perspective. A mixed method-approach was used to collect information, design a questionnaire and a discrete-choice exercise, and elicit the unmet needs through a multidisciplinary committee composed of 12 experts. A total of 65 unmet needs were identified and categorized into 4 areas: clinical, patient-related, decision-making process, and social. Decision-making process unmet needs were perceived as the most pressing ones, followed by social, clinical and patient-related. Individually, the need to incorporate outcomes that are important to the patients and to have treatments that achieve total clearance with a rapid onset of action and long-term persistence were the most important unmet needs.


Subject(s)
Psoriasis , Quality of Life , Exercise , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Spain/epidemiology , Surveys and Questionnaires
20.
Contrast Media Mol Imaging ; 2022: 6092808, 2022.
Article in English | MEDLINE | ID: mdl-35340911

ABSTRACT

Objective: This study aimed to estimate serum IL-17A and Claudin-1 levels, investigate their correlation, and evaluate their diagnostic significance as potential blood-based biomarkers in psoriasis. Methods: Serum IL-17A and Claudin-1 concentrations were determined using enzyme-linked immunosorbent assay (ELISA). Statistical analyses were performed to determine differences in serum levels of IL-17A and Claudin-1, their bivariable correlation with psoriasis severity, as Psoriasis Area Severity Index (PASI), and their predictive abilities using receiver operating characteristic (ROC) curves. Results: Significantly higher IL-17A and lower Claudin-1 levels were found in psoriasis (p < 0.05). PASI did not correlate significantly with either IL-17A or Claudin-1 in psoriasis and their subtypes. The only significant correlation between serum IL-17A and Claudin-1 was shown in late-onset psoriasis (r = 0.630, p = 0.028). ROC curve analysis indicated the serum IL-17A, serum Claudin-1, and combination of IL-17A and serum Claudin-1 for predicting psoriasis with the areas under the curve (AUC) of 0.951 (p < 0.0001), 0.709 (p = 0.0119), and 0.949 (p < 0.0001), respectively. Moreover, the potential role in distinguishing between early-onset and late-onset psoriasis: we obtained serum IL-17A, serum Claudin-1, and their combination AUC of 0.590 (p = 0.3126), 0.741 (p = 0.0045), and 0.741 (p = 0.0067), respectively. However, none of the serum IL-17A, serum Claudin-1, and their combination was well-performed discriminating mild psoriasis from moderate-to-severe psoriasis with AUC of 0.553 (p = 0.5596), 0.518 (p = 0.8539), and 0.559 (p = 0.5225), respectively. Conclusion: These preliminary results suggest that the serum Claudin-1 as a potential biomarker and the relationship and possible regulatory interactions between IL-17A and Claudin-1 in psoriasis are distinguishable by age of onset.


Subject(s)
Claudin-1/metabolism , Interleukin-17/blood , Psoriasis , Biomarkers , Claudins , Cytokines , Humans , Interleukin-17/metabolism , Psoriasis/diagnosis , Psoriasis/metabolism
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